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Novick KK, Novick J. A Two-Systems Engagement with the Psychoanalytic Model of Adolescence. PSYCHOANALYTIC STUDY OF THE CHILD 2022. [DOI: 10.1080/00797308.2022.2137365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Jack Novick
- Contemporary Freudian Society, Michigan Psychoanalytic Society
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Grover JM. Bonding with your hard of hearing or late-deafened VR client. JOURNAL OF VOCATIONAL REHABILITATION 2017. [DOI: 10.3233/jvr-170882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- James M. Grover
- School of Counseling, Human Performance and Rehabilitation, College of Education and Health Professions, University of Arkansas at Little Rock, 2801 South University Avenue, Little Rock, AR 72204, USA. Tel.: +1 501 683 7084; Fax: +1 501 569 8129; E-mail:
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Kolden GG, Howard KI, Maling MS. The Counseling Relationship and Treatment Process and Outcome. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000094221004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The quality of the counseling relationship has consistently been found to have the most significant impact on successful client outcome. Yet the definition and critical components of a quality counseling relationship remain in question. This article is a systematic review of studies of the counseling relationship intended to identify the present empirical understanding of this essential element of counseling. Using the multidimensional model proposed by Gelso & Carter, empirical support for the "real, " "unreal, " and "working alliance" elements of the relationship are summarized. Studies investigating the interactional nature of the counseling relationship are also reported. In addition, implications of a potential "paradigm" shift in thinking of the counseling relationship are discussed in regard to the development of theoretical models and future research agendas. In particular, the authors outline how the adoption of a social constructivist perspective would change the focus of the theoretical models and systematic research.
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Abstract
One mission of the International Forum section in The Counseling Psychologist is to increase the globalization of counseling psychology (Leong & Ponterotto, 2003). The goals of this study are in line with this mission: (a) to replicate U.S. counseling research on the working alliance to Taiwan by examining clients’perceptions of their counselors’ credibility and (b) to extend the working-alliance literature by examining the role that counselors’problem-solvingstyles play in predicting the initial working alliance. Thirty-one counseling dyads from four counseling centers in Taiwan participated by completing inventories after their first counseling sessions. Results found that (a) clients’ perceptions of their counselors’ credibility and (b) counselors’ perceptions of their problemsolving styles significantly predicted the client-rated, but not the counselor-rated, working alliance. Counseling implications and recommendations for future research are discussed.
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Brandtner M, Serralta FB. Terapia Cognitivo-Comportamental para Compras Compulsivas: Um Estudo de Caso Sistemático. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-37722016012116181188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O presente estudo de caso sistemático examinou o processo e os resultados da terapia cognitivo-comportamental (TCC) de uma compradora compulsiva. A duração do tratamento foi pré-definida em 12 sessões. Todas as sessões foram codificadas com o Psychotherapy Process Q-Set (PQS), um método empírico de avaliação do processo terapêutico. Medidas de resultados incluíram a avaliação de sintomas de depressão, ansiedade e compras compulsivas, bem como do ajustamento social. Houve mudança clinicamente significativa e confiável nos sintomas e no ajustamento social, após o tratamento. A análise do processo indicou que fatores da terapeuta (empatia e responsividade), fatores da paciente (colaboração), fatores da relação (aliança terapêutica) e fatores técnicos (apoio e tarefas de casa) contribuíram para as mudanças observadas.
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Novick KK, Novick J. A new model of techniques for concurrent psychodynamic work with parents of child and adolescent psychotherapy patients. Child Adolesc Psychiatr Clin N Am 2013; 22:331-49. [PMID: 23538016 DOI: 10.1016/j.chc.2012.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To address the neglect of the importance of parent work in the psychodynamic psychotherapy of children and adolescents, the authors present a model of concurrent dynamic parent work that has demonstrated success with patients of all ages. The model includes dual goals for all therapies, addresses the challenge of confidentiality by differentiating privacy and secrecy, and emphasizes the importance of parent work throughout treatment.
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Versaevel C, Samama D, Jeanson R, Lajugie C, Dufeutrel L, Defromont L, Lebouteiller V, Danel T, Duhamel A, Genin M, Salleron J, Cottencin O. [Determine the patient's position towards psychiatric care: a simple tool to estimate the alliance and the motivation]. Encephale 2013; 39:284-91. [PMID: 23537638 DOI: 10.1016/j.encep.2012.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 11/28/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES For the brief systemic therapy (BST), the evaluation of the patient's position towards the care is a prerequisite to psychotherapy. Three positions of the patient are described. The "tourist's" position: the patient claims to have no problem and doesn't suffer. Someone asks him to make an appointment, sometimes with threats. The "complaint's" position: the patient claims to suffer, but attributes the responsibility of this suffering to others. These two positions are not good for beginning a therapy. The "customer's" position differs from both previous positions. The "customer" considers that he has a psychological problem which depends on him and he is motivated in the resolution of it. In theory, the "customer" is more motivated and the therapeutic alliance is better. It is for this reason that the BST estimates the position of the patient at first, to bring the patient to the "customer's" position. The objective of this study is to assess an interview which identifies the patient's position towards the care, and to validate the theoretical elaborations of the brief systemic therapy. METHOD The study concerns the follow-up of outpatients who consult a psychiatrist for the first time. The evaluation of the patients checks their position towards care using the Tourist-Complaint-Customer (TCC) inventory, how they suffer, the therapeutic alliance (scale Haq-2) and the compliance during care. The evaluation by the psychiatrists checks the suffering perceived, the motivation perceived and the diagnoses according to the DSM. RESULTS The typology of these patients is made up of one half "complaint", a quarter of "tourist" and a quarter of "customer". The "customer's" position is correlated with the therapeutic alliance and the motivation perceived by the psychiatrist. The motivation perceived by the psychiatrist is correlated with the therapeutic alliance. These results correspond to the theoretical elaborations of the BST. CONCLUSION the TCC inventory provides information on the motivation and the therapeutic alliance. If the patient is in "tourist" or "complaint" position, we recommend that the psychiatrist "work" to bring the patient to "customer" position. The evaluation of the position of the patient is simple and rich in information. We recommend that it be given a place in the daily practice of psychiatry.
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Affiliation(s)
- C Versaevel
- Secteur 59G07, établissement public de santé mentale Lille-Métropole, rue du Général-Leclerc, BP 10, 59487 Armentières cedex, France.
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Mirdal GM, Ryding E, Essendrop Sondej M. Traumatized refugees, their therapists, and their interpreters: three perspectives on psychological treatment. Psychol Psychother 2012; 85:436-55. [PMID: 23080532 DOI: 10.1111/j.2044-8341.2011.02036.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study how traumatized refugees, their therapists, and their interpreters perceive both curative and hindering factors in psychological therapy, thereby highlighting the mediators of change in a transcultural clinical setting. DESIGN Four experienced clinical psychologists affiliated to two centres for the rehabilitation of traumatized refugees, were asked to select their two 'most successful' and two 'least successful' cases by going back to all the cases that they had concluded within the last 2 years, a pool of approximately 200 patients. The selected 16 patients, their therapists, and their interpreters were invited to semi-structured, in-depth, individual interviews with the aim of acquiring more knowledge on what had been helpful and what not helpful in the psychological treatment. METHOD The senior author who conducted the interviews was not aware of whether the patient belonged to the 'successful' or 'unsuccessful group' prior to the interview. All interviews were audio taped. A qualitative phenomenological approach was used in the analysis of the data. The data were analysed (1) triad by triad for the 16 triads consisting of a patient, his/her therapist, and his/her interpreter, and (2) separately for each of the three groups of respondents. The analysis involved going through each protocol sentence by sentence and developing key-concepts for the therapeutic interventions and for the interpersonal relations. When the generation of key-concepts was finalized, the material was analysed for a second time, in order to place the relevant data under the key-concepts/categories. The categories and illustrative verbatim quotations from the interviews are presented in separate tables for the three groups. RESULTS The relationship between the therapist, patient, and interpreter, and the development of trust and a good working alliance was seen by all as the most important curative factor. Psychoeducative methods, cognitive interventions, as well as the provision of practical help and advice were also regarded as curative and facilitating factors. Hindering factors fell into the following five categories: factors related to the patient, to the therapist, to the interpreter, to the therapeutic method itself, and to factors external to the therapy. Therapists and interpreters considered severe psychopathology and substance abuse in addition to PTSD; chronic pain and physical illness; lack of motivation for treatment; and overwhelming social and/or economic problems as obstructive factors for the establishment of a working alliance and more generally for a successful outcome. As to the patients who did not benefit from the treatment, the unsuitability of a psychological treatment for their symptoms, and social and economic problems were seen as the main hindering factors. CONCLUSION The therapeutic or working alliance is a common element of all types of psychological treatments, and is generally considered as a 'non-specific' factor. There are grounds to modify this view in working with traumatized and tortured patients from different cultural backgrounds. In cases where patients have experienced humiliation and evil, and now live in exile, the establishment of a relation of trust in fellow human beings is the first aim of the treatment. The article argues that the professional's compassion constitutes a primary factor in the therapeutic process in such cases. The risks of overinvolvement in the treatment of heavily traumatized patients are well described in the literature, and have also appeared in this study. In psychotherapy research, strong personal commitment is seldom mentioned by therapists for fear of its being considered unprofessional or unethical. However, a strong commitment can be of value, not only for the patients, but also for the therapists and interpreters themselves. The results of this study suggest that deep compassion on the part of the professionals is widespread in the treatment of traumatized patients, and that it is considered as a healing factor by most patients, interpreters, and therapists.
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Affiliation(s)
- Gretty M Mirdal
- Department of Psychology, University of Copenhagen, Denmark.
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Hirsh JB, Quilty LC, Bagby RM, McMain SF. The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder. J Pers Disord 2012; 26:616-27. [PMID: 22867511 DOI: 10.1521/pedi.2012.26.4.616] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The working alliance between therapist and patient is an important component of effective interventions for borderline personality disorder (BPD). The current study examines whether client personality affects the development of the working alliance during the treatment of BPD, and whether this influences treatment effectiveness. Data was based on 87 patients with BPD who were participants in a randomized controlled trial comparing Dialectical Behavior Therapy (DBT) and general psychiatric management. Higher levels of trait Agreeableness were associated with steeper increases in working alliance throughout treatment, but only in the DBT condition. Increases in working alliance were in turn associated with better clinical outcomes. Mediation models revealed a significant indirect path from Agreeableness to better clinical outcomes, mediated through larger improvements in working alliance over time. These results highlight the role that patient personality can play during the therapeutic process, with a specific focus on the importance of Agreeableness for alliance development.
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Mattison M. Social work practice in the digital age: therapeutic e-mail as a direct practice methodology. SOCIAL WORK 2012; 57:249-258. [PMID: 23252316 DOI: 10.1093/sw/sws021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The author addresses the risks and benefits of incorporating therapeutic e-mail communication into clinical social work practice. Consumer demand for online clinical services is growing faster than the professional response. E-mail, when used as an adjunct to traditional meetings with clients, offers distinct advantages and risks. Benefits include the potential to reach clients in geographically remote and underserved communities, enhancing and extending the therapeutic relationship and improving treatment outcomes. Risks include threats to client confidentiality and privacy, liability coverage for practitioners, licensing jurisdiction, and the lack of competency standards for delivering e-mail interventions. Currently, the social work profession does not have adequate instructive guidelines and best-practice standards for using e-mail as a direct practice methodology. Practitioners need (formal) academic training in the techniques connected to e-mail exchanges with clients. The author describes the ethical and legal risks for practitioners using therapeutic e-mail with clients and identifies recommendations for establishing best-practice standards.
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Affiliation(s)
- Marian Mattison
- Department of Social Work, Providence College, Providence, RI 02918, USA.
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Kivlighan DM, Clements L, Blake C, Arnzen A, Brady L. Counselor Sex Role Orientation, Flexibility, and Working Alliance Formation. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6676.1993.tb02284.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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L’alliance thérapeutique en psychothérapie : apports de la recherche empirique. Encephale 2010; 36:433-8. [DOI: 10.1016/j.encep.2010.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 12/15/2009] [Indexed: 11/22/2022]
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Hervé MJ, Grandjean H, Visier JP, Maury M. Triadic nonverbal communication in mother-infant consultations: Two contrasted cases. Infant Ment Health J 2009. [PMID: 28636227 DOI: 10.1002/imhj.20213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of the present case study was to present and discuss the analysis of triadic nonverbal communication between mother, infant, and therapist in two early consultations as an indicator of the therapeutic alliance. The analysis explored nonverbal triadic interactions (body positions and facial orientations of the mother, infant, and therapist, and expressive behaviors of the infant) and triadic affective sharing (via a microanalytic interview of the therapist). The quality of the therapeutic alliance and clinical outcome for each case are described. The description of the two cases illustrates the importance of the progressive development of nonverbal "engagement" by the three people (triadic alliance) and of moments with triadic emotional sharing. The contribution of the therapist appears to be crucial, in particular via his or her body and affective engagement with the infant. The triadic alliance appears to be both an indicator of the therapeutic alliance and an element that can foster it.
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Affiliation(s)
- M J Hervé
- St Eloi Hospital, F-34295 Montpellier Cedex 5, France
| | - H Grandjean
- Paul Sabatier University, 31073 Toulouse Cedex, France
| | | | - M Maury
- St Eloi Hospital, F-34295 Montpellier Cedex 5, France
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Shelef K, Diamond GM. Short form of the revised Vanderbilt therapeutic alliance scale: development, reliability, and validity. Psychother Res 2008; 18:433-43. [PMID: 18815995 DOI: 10.1080/10503300701810801] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This study presents the development and psychometric properties of a five-item version of the revised Vanderbilt Therapeutic Alliance Scale (VTAS-R Short Form). A total of 255 alliance ratings, derived from therapy sessions from 86 cases of family therapy for substance-abusing adolescents, were used to generate two separate subsamples. The first subsample was used to develop the five-item form and the second subsample to estimate the measure's reliability and concurrent and predictive validity. The VTAS-R Short Form evidenced high internal consistency, was highly correlated with the full-length VTAS-R, and predicted treatment completion and adolescents' days of cannabis use at 3 months follow-up. The findings suggest that the VTAS-R Short Form is a reliable and valid alternative to the full-length form.
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Affiliation(s)
- Karni Shelef
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Clinical, empirical, and developmental perspectives on the therapeutic relationship in child psychotherapy. Dev Psychopathol 2008. [DOI: 10.1017/s0954579400004946] [Citation(s) in RCA: 219] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractDespite substantial interest in the therapeutic relationship by child clinicians, relationship processes in child therapy have been neglected by clinical researchers. In this paper, clinical and empirical perspectives on the therapeutic relationship in child treatment were reviewed. Initial findings indicated that the quality of the child's affective relationship with the therapist is associated with collaboration on therapy tasks. Given the recurrent finding of links between treatment collaboration and treatment outcome, research on factors that influence children's ability to form therapeutic relationships is recommended. To this end, a developmental social cognitive model of therapeutic alliance formation is proposed.
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Krikorian SE, Fowler JC. A View from Riggs: Treatment Resistance and Patient Authority—VII. A Team Approach to Treatment Resistance. ACTA ACUST UNITED AC 2008; 36:353-73. [DOI: 10.1521/jaap.2008.36.2.353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Anderson RM, Funnell MM. The art and science of diabetes education: a culture out of balance. DIABETES EDUCATOR 2008; 34:109-17. [PMID: 18267997 DOI: 10.1177/0145721707312398] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the past 20 years, behavioral science has helped create a growing body of theoretically derived, evidenced-based approaches to diabetes patient education. Health care professionals in all disciplines are being required to demonstrate that their practice is evidence based. For diabetes educators, behavioral science is the source of much of that evidence. However, effective diabetes education involves a combination of art and science. Establishing a therapeutic alliance with patients is an art. Diabetes educators must have the interpersonal skills, values, and personal traits needed to cultivate relationships with patients that are characterized by trust, respect, and acceptance. They must feel and be able to express compassion, empathy, and warmth. However, if someone outside the field were reviewing diabetes education evaluation research, they would probably conclude that diabetes educators are interchangeable cogs in a wheel. The positive impact of the therapeutic alliance is well documented in the counseling, psychotherapy, education, and nursing literature. However, evidence to support the important role of the diabetes educator's values, interpersonal skills, and ability to establish a therapeutic alliance with patients is absent from that literature. Valid and reliable measures used to document the impact of interpersonal skills counselors and teachers could be used in diabetes education with little or no adaptation. The evidence and tools exist; we now need to determine if the will exists.
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Affiliation(s)
- Robert M Anderson
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor
| | - Martha M Funnell
- The Department of Medical Education, University of Michigan Medical School, Ann Arbor
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Messer SB. Integration and eclecticism in counselling and psychotherapy: Cautionary notes. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2007. [DOI: 10.1080/03069888908260039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Stanley B. Messer
- a Graduate School of Applied and Professional Psychology , Rutgers University , USA
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Barkham M. Empathy in Counselling and Psychotherapy: Present status and future directions. COUNSELLING PSYCHOLOGY QUARTERLY 2007. [DOI: 10.1080/09515078808254226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ablon JS, Levy RA, Katzenstein T. Beyond brand names of psychotherapy: Identifying empirically supported change processes. ACTA ACUST UNITED AC 2006; 43:216-31. [DOI: 10.1037/0033-3204.43.2.216] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shelef K, Diamond GM, Diamond GS, Liddle HA. Adolescent and parent alliance and treatment outcome in multidimensional family therapy. J Consult Clin Psychol 2005; 73:689-98. [PMID: 16173856 DOI: 10.1037/0022-006x.73.4.689] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent alliance predicted adolescents' substance abuse and dependency symptoms at posttreatment, as well as days of cannabis use at 3-month follow-up. The association between adolescent alliance and substance abuse and dependency symptoms at posttreatment was moderated by the strength of the parent alliance. Results reveal the unique and interactive effects of the 2 alliances on treatment outcome and emphasize the need for a systemic and well-articulated approach to developing and maintaining the multiple alliances inherent to family therapy.
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Affiliation(s)
- Karni Shelef
- Department of Behavioral Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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What Do Couples Find Most Helpful About the Reflecting Team? JOURNAL OF COUPLE & RELATIONSHIP THERAPY-INNOVATIONS IN CLINICAL AND EDUCATIONAL INTERVENTIONS 2005. [DOI: 10.1300/j398v04n04_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hilsenroth MJ, Peters EJ, Ackerman SJ. The Development of Therapeutic Alliance During Psychological Assessment: Patient and Therapist Perspectives Across Treatment. J Pers Assess 2004; 83:332-44. [PMID: 15548469 DOI: 10.1207/s15327752jpa8303_14] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn & Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher & Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.
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Affiliation(s)
- Mark J Hilsenroth
- Derner of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA
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Cartwright D. Anticipatory interpretations: addressing "cautionary tales" and the problem of premature termination. Bull Menninger Clin 2004; 68:95-114. [PMID: 15262614 DOI: 10.1521/bumc.68.2.95.35946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article explores the use of anticipatory interpretations early in the therapeutic process as a means of addressing the problem of premature termination with some patients. The author argues that emerging transference references, detected through a close attention to "cautionary tales" or derivative communications, should be used in early interpretive interventions. It is suggested that such transference references form a "template of intention" that help determine future difficulties in the therapeutic alliance. Being able to communicate these observations in a future-orientated way lays the groundwork for "thinking about" actions that threaten the therapeutic alliance when they occur, in turn curtailing the possibility of acting out through termination. The author uses two case examples to illustrate his observations and goes on to suggest that anticipatory interpretations involve: (1) isolating derivatives and underlying anxieties, (2) future-orientated transference references, and (3) an affirmation of difficulty.
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Taft CT, Murphy CM, Musser PH, Remington NA. Personality, interpersonal, and motivational predictors of the working alliance in group cognitive-behavioral therapy for partner violent men. J Consult Clin Psychol 2004; 72:349-54. [PMID: 15065967 DOI: 10.1037/0022-006x.72.2.349] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies have demonstrated that the working alliance predicts treatment outcome for partner violent men. This study examined the influence of personality and interpersonal characteristics, motivational readiness to change, and demographic factors on working alliance formation among a sample of men (N = 107) participating in a cognitive-behavioral group treatment program for partner violence. Motivational readiness to change was the strongest predictor of the working alliance. Psychopathic personality characteristics also emerged as a strong (negative) predictor of the working alliance. Lower levels of borderline personality characteristics and interpersonal problems, self-referred status, married status, and higher age and income predicted higher working alliance ratings. The results support recent clinical efforts to address motivational readiness in programs for partner violent men.
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Affiliation(s)
- Casey T Taft
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA 02130, USA.
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Taft CT, Murphy CM, King DW, Musser PH, DeDeyn JM. Process and treatment adherence factors in group cognitive-behavioral therapy for partner violent men. J Consult Clin Psychol 2003; 71:812-20. [PMID: 12924686 DOI: 10.1037/0022-006x.71.4.812] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used multilevel modeling to examine process and treatment adherence factors as predictors of collateral partner reports of abuse following participation in a cognitive-behavioral grouptreatment program for partner violent men (N = 107). Therapist working alliance ratings predicted lower levels of physical and psychological abuse at the 6-month follow-up and were the strongest predictors of outcome. Homework compliance partially mediated associations between early alliance ratings and psychological abuse at follow-up. Greater group cohesion during treatment, assessed byclient report, also predicted lower physical and psychological abuse at follow-up. The findings support the promotion of a collaborative therapeutic environment to induce change among partner violent men.
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Affiliation(s)
- Casey T Taft
- Department of Psychology, University of Maryland, Baltimore County, 21250, USA
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Abstract
The author traces some of the literature related to such concepts as the development of the therapeutic alliance and collaboration in the inpatient and residential psychiatric treatment of disturbed adolescents. The more recently developed concept of "mentalization" is discussed, especially with its relevance to the psychotherapy of difficult-to-treat adolescent patients. A case presentation highlights the establishment of relatedness and trust with such a patient. The case is described in terms of the mental activities of both therapist and patient that facilitated the psychotherapy process in a number of ways. Mentalization is seen as a useful concept, both in terms of understanding the process of psychotherapy, and as a fundamental attribute of the mental activities of the therapist and, likewise, fostered in the patient.
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Affiliation(s)
- Flynn O'Malley
- Adolescent Treatment Program, The Menninger Clinic, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77080, USA.
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Marcolino JAM, Iacoponi E. The early impact of therapeutic alliance in brief psychodynamic psychotherapy. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2003; 25:78-86. [PMID: 12975703 DOI: 10.1590/s1516-44462003000200006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Therapeutic alliance is a key component of the psychotherapeutic process. This study estimated the impact of the therapeutic alliance as measured by CALPAS-P in an individual brief psychodynamic psychotherapy program. METHODS To study the impact of the therapeutic alliance patients in psychotherapy answered to the CALPAS-P at the first and third session and to the Self-report Questionnaire (SRQ-20), to the Beck Depression Inventory (BDI) and to the Hamilton Anxiety Scale at the beginning and at the end of psychotherapy. RESULTS The study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher TUI scores in the first session were significantly associated to the improvement on the BDI. Patients with best scores in the working alliance, measured at the third PWC session had also significant symptomatic changes. DISCUSSION The study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.
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DeVet KA, Kim YJ, Charlot-Swilley D, Ireys HT. The therapeutic relationship in child therapy: perspectives of children and mothers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2003; 32:277-83. [PMID: 12679286 DOI: 10.1207/s15374424jccp3202_13] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Examined qualities of the therapeutic relationship as perceived by low-income children who were in treatment for serious emotional disorders and their mothers. Recent emphasis on engaging families in the treatment of their children highlights the importance of understanding processes that facilitate therapeutic partnerships. Therapeutic bonds (i.e., the closeness of the relationship to therapist) for both children and their mothers were assessed. One-hundred fifty-seven families participated. Cross-sectional analyses indicated that children's perceptions of closeness with their therapists were associated with their perceptions of closeness with their mothers, their own age, and welfare status of the family. Maternal therapy bond scores were associated with mental health services efficacy and breadth of social support.
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Affiliation(s)
- Katherine A DeVet
- Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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34
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Ackerman SJ, Hilsenroth MJ. A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clin Psychol Rev 2003; 23:1-33. [PMID: 12559992 DOI: 10.1016/s0272-7358(02)00146-0] [Citation(s) in RCA: 395] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The present review is a comprehensive examination of the therapist's personal attributes and in-session activities that positively influence the therapeutic alliance from a broad range of psychotherapy perspectives. Therapist's personal attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open were found to contribute positively to the alliance. Therapist techniques such as exploration, reflection, noting past therapy success, accurate interpretation, facilitating the expression of affect, and attending to the patient's experience were also found to contribute positively to the alliance. This review reveals how these therapist personal qualities and techniques have a positive influence on the identification or repair of ruptures in the alliance.
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Affiliation(s)
- Steven J Ackerman
- The Austen Riggs Center, P.O. Box 962, 25 Main Street, Stockbridge, MA 01262, USA.
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Cyranowski JM, Bookwala J, Feske U, Houck P, Pilkonis P, Kostelnik B, Frank E. Adult Attachment Profiles, Interpersonal Difficulties, and Response to Interpersonal Psychotherapy in Women with Recurrent Major Depression. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2002. [DOI: 10.1521/jscp.21.2.191.22514] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marcolino JAM, Iacoponi E. Escala de Aliança Psicoterápica da Califórnia na versão do paciente. BRAZILIAN JOURNAL OF PSYCHIATRY 2001. [DOI: 10.1590/s1516-44462001000200007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: A aliança terapêutica corresponde a um conceito central do processo psicoterápico. Este estudo produziu a tradução para o português e examinou a confiabilidade da Calpas-P (Escala de Aliança Psicoterápica da Califórnia - versão do paciente). MÉTODOS: Para a tradução, foi adotada a técnica da retrotradução, realizada por indivíduos bilíngües. Para o estudo de confiabilidade, uma amostra de profissionais de saúde mental, atendidos em psicoterapia individual, foi convidada para responder a versão em português da Calpas-P. RESULTADOS: Um total de 83 questionários foi devolvido. As médias das quatro escalas da Calpas-P foram: 5,66 para a PC; 5,20 para a PWC; 6,10 para a TUI; e 5,99 para a WSC. As escalas mostraram uma alta correlação entre si, com valores variando de 0,57 a 0,74. O Alpha de Cronbach para a Calpas-P também foi alto: 0,90 para todos os itens; 0,71 para a PC; 0,56 para a PWC; 0,71 para a TUI; e 0,84 para a WSC. CONCLUSÃO: Esses coeficientes apresentaram índices superiores, quando comparados àqueles do estudo original, na versão em inglês. A presente investigação, que tornou disponível a versão em português da Calpas-P e algumas de suas características psicométricas, pode contribuir para uma mensuração mais cuidadosa da aliança terapêutica por meio de sua inclusão em pesquisas futuras na psicoterapia.
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Etheridge RM, Hubbard RL. Conceptualizing and assessing treatment structure and process in community-based drug dependency treatment programs. Subst Use Misuse 2000; 35:1757-95. [PMID: 11138707 DOI: 10.3109/10826080009148240] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Having established the effectiveness of drug dependency treatment, the next generation of research will necessitate a focus on treatment structure and process and the systems within which programs operate. As a foundation for a process conceptualization, we constructed a grounded theory definition of treatment consisting of core elements and related comprehensive services. We then presented the multilevel conceptual framework that guided the Drug Abuse Treatment Outcome Study (DATOS) treatment structure and process study design and instrumentation, anchored by supporting empirical literature. The framework emphasizes seven critical levels of process measurement that future research should consider in order to avoid potential spurious findings.
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Affiliation(s)
- R M Etheridge
- National Development and Research Institute, Inc., Institute for Community-Based Research, Raleigh, North Carolina 27606, USA
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38
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Ackerman SJ, Hilsenroth MJ, Baity MR, Blagys MD. Interaction of therapeutic process and alliance during psychological assessment. J Pers Assess 2000; 75:82-109. [PMID: 10941703 DOI: 10.1207/s15327752jpa7501_7] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Utilizing a collaborative therapeutic assessment (TA) model proposed by Finn and Tonsager (1997), we examined the interaction between therapeutic alliance and in-session process during the assessment phase of treatment. This study compares the utility of the TA model (n = 38) versus a traditional information gathering model (n = 90) of assessment. The results of this study indicate that the use of a TA model may decrease the number of patients who terminate treatment against medical advice. The Session Evaluation Questionnaire (Stiles & Snow, 1984), Combined Alliance Short Form (Hatcher & Barends, 1996), and Penn Helping Alliance Questionnaire-Revised (Barber & Crits-Christoph, 1996) can reliably measure the patient's experience of the assessment. The psychological assessment process may impact the patient's experience of assessment feedback and aid in the development of a therapeutic alliance. The therapeutic alliance developed during the assessment was found to be related to alliance early in psychotherapy. We discuss the theoretical, clinical, and research implications of these findings.
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Affiliation(s)
- S J Ackerman
- Department of Psychology, University of Arkansas, USA.
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39
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Affiliation(s)
- R F Demarco
- Northeastern University and the Bouve College of Health Sciences, School of Nursing, Boston, Massachusetts
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40
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Butler MH, Bird MH. Narrative and interactional process for preventing harmful struggle in therapy: an integrative empirical model. JOURNAL OF MARITAL AND FAMILY THERAPY 2000; 26:123-142. [PMID: 10776601 DOI: 10.1111/j.1752-0606.2000.tb00284.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Resistance or struggle in therapy looms large as a predictor of treatment outcomes. This study organizes the significant empirical data on struggle into a coherent, operational framework for use by therapists in preventing and/or ameliorating harmful struggle in therapy. First, we review the prevalence and significance of struggle. Second, we offer a historical and conceptual overview, with emphasis on a contemporary interactional/systemic perspective on struggle. Third, we provide a synthesis of peer-reviewed research, profiling struggle at speech-act and episode levels of interaction process and across assessment/joining, intervention, and integration-consolidation phases of therapy. Fourth, based upon this review, we propose a three-factor model--consisting of eliciting dialogue, enactments, and accommodation--for successful therapy process relative to the occurrence of struggle.
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Affiliation(s)
- M H Butler
- School of Family Life, Marriage and Family Therapy Graduate Programs, Brigham Young University, Provo, UT 84602-8601, USA.
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41
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Kivlighan DMJ, Shaughnessy P. Patterns of working alliance development: A typology of client's working alliance ratings. J Couns Psychol 2000. [DOI: 10.1037/0022-0167.47.3.362] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Therapist-couple struggle vs. cooperation is linked to clinical outcome. This research conceptualizes and investigates treatment process as it relates to the occurrence of struggle versus cooperation. Models of couple-responsible and therapist-responsible process in couple therapy were developed. Couple-responsible process consists of enactments, accommodation, and inductive process. Therapist-responsible process consists of primary therapist-couple interaction, therapist interpretation, and direct instruction. In counterbalanced order, 25 couples were exposed to couple-responsible and therapist-responsible episodes during one therapy session. Couples reviewed videotapes of the episodes and completed measures of responsibility, struggle, and cooperation. Perceived responsibility was higher and struggle was lower during couple-responsible episodes. No difference in cooperation was found. Presence or absence of a contrast condition, where couples reported on one therapist process after already experiencing its opposite, led to main effects for responsibility and struggle, and mediated effects of struggle and cooperation. Generally speaking, responsibility was even higher during couple-responsible episodes and even lower during therapist-responsible episodes when contrast was present. Similarly, struggle was even lower during couple-responsible episodes and even higher during therapist-responsible episodes when contrast was present. For both couple-responsible and therapist-responsible episodes, cooperation was negatively affected by a shift from the prior, opposite therapist process. Significant proportions of the variance in responsibility, struggle, and cooperation, however, were not accounted for by therapist process alone.
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Affiliation(s)
- M H Butler
- School of Family Life, Brigham Young University, Provo, UT 84602-8601, USA.
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43
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Novick KK, Novick J. An application of the concept of the therapeutic alliance to sadomasochistic pathology. J Am Psychoanal Assoc 1998; 46:813-46. [PMID: 9795893 DOI: 10.1177/00030651980460031301] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.
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Clients' Expectations About Counseling and Perceptions of the Working Alliance. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 1996. [DOI: 10.1300/j035v11n02_03] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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Abstract
The Zone of Proximal Development (ZPD) is discussed, a construct that, when introduced into psychoanalysis, advances understanding of the key clinical relationship between the intrapsychic and the interpersonal. Strands from several psychoanalytic formulations are brought together and forged into a coherent construct, which is then contrasted with the transference. It is shown how the ZPD provides the transference with its mutative potential. Just as the transference provides the motivation for the recruitment of objects to accomplish its purposes (repetition), the ZPD leads to the recruitment of objects in order to accomplish its purposes (to learn by ushering individuals into a speech and internalization community). Under the sway of the transference objects are sought so that early disregulating experiences can be repeated and an opportunity provided for a better resolution. The ZPD works in tandem with the transference, capitalizing on the impetus provided, allowing for the possibility of internalization, a beneficial outcome to transference repetition which otherwise would have no agent of conflict resolution. In analysis, when the transference and the ZPD enjoin smoothly, the potential outcome is "insight" in a broad sense. The processes of the ZPD define the optimal interpersonal context of psychoanalysis, one that allows the intrapsychic to be best reached by analytic interventions. Given the inevitability of mutual influences between analyst and analysand, the analyst strives simultaneously to be in the ZPD yet outside the transference with the analysand, a crucial tension that is a constant, precarious technical factor. This useful tension casts light on such procedural guides as optimal frustration and abstinence.
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Affiliation(s)
- A Wilson
- Clinical Psychology Doctoral Program, Seton Hall University, USA
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47
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Sadavoy J. Integrated psychotherapy for the elderly. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1994; 39:S19-26. [PMID: 7828118 DOI: 10.1177/070674379403908s04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The complexity of interacting variables in the geriatric patient imposes the therapeutic necessity to employ all effective therapeutic modalities in an interactive and integrated fashion. This paper examines the efficacy data on brief and longer term therapies as applied to the elderly, most particularly for treatment of depression and bereavement. In determining the development of an integrated psychotherapy treatment plan, the author suggests a decision pathway which incorporates concurrent utilization of theoretical principles derived from psychodynamic, interpersonal and cognitive behavioural theory. This tripartite approach informs the assessment and diagnosis of the patient as well as the specific choice of therapy. Directions for further research are suggested.
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Affiliation(s)
- J Sadavoy
- Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario
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48
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Abstract
An ongoing controversy in the field of group psychotherapy is whether transference regression is greater in groups than in individual treatment. There appears to be a general consensus that group behavior may be understood as operating on at least three levels--the conscious--rational, the oedipally determined transference, and the preoedipal maternal transference level. The more rational levels are associated with transference dilution, whereas the more primitive levels accompany transference intensification. Dilution occurs as a result of reality demands and inputs of the group situation and because of multiple targets of displacement. Transference intensification is a product of mutual stimulation, contagion effect, frustrating inputs, and support of the group theme. Certain patients benefit most from the dilution features of a group, and others profit most from intensification. The therapist's technique and the patient's pathology are the main determinants of which aspect gets emphasized and utilized.
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Affiliation(s)
- L Horwitz
- Menninger Clinic, Topeka, Kansas 66601
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49
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Des Rosiers P. Separation-individuation issues in sister transference. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHOANALYSIS 1993; 21:273-289. [PMID: 8349491 DOI: 10.1521/jaap.1.1993.21.2.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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50
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Martin J. Conceptual investigations in counseling psychology: Three candidates to fill the gap. COUNSELLING PSYCHOLOGY QUARTERLY 1992. [DOI: 10.1080/09515079208254449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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